Metotreksata Baðlý Geliþen Pulmoner Toksisite

Folat antagonisti olan metotreksat, inflamatuvar ve neoplastik hastalýklarda kullanýlýr. Metotreksat kullanýmýna baðlý pulmoner toksisite nadirdir. Romatoid artrit nedeniyle 3 ay önce haftada bir 10 mg intramuskuler metotreksat ve 4 mg prednizolon baþlanan 67 yaþýnda kadýn hastada, nefes darlýðý, öksürük, ateþ ve aðýz içinde yara yakýnmalarý ortaya çýkmasý, toraks bilgisayarlý tomografide her iki akciðerde üst loblarda periferik yerleþimli ve alt loblarda alveolar düþük dansitede opasiteler ve konsolide alanlarýn görülmesi üzerine olasý dispne nedenleri dýþlanmýþ, klinik ve radyolojik olarak metotreksata baðlý pulmoner toksisite düþünülmüþ ve kortikosteroid tedavisi ile belirgin düzelme saðlanmýþtýr. Taný ve tedavide gecikme ölümcül sonuçlara yol açabileceði için metotreksat kullanýmýna baðlý pulmoner toksisite geliþebileceði akla getirilmelidir.

Methotrexate-related Pulmonary Toxicity

Methotrexate (folate-antagonist) is used in the treatment of several inflammatory and neoplastic diseases. However pulmonary toxicity due to methotrexate is uncommon. Herein, we present a 67-year-old woman with rheumatoid arthritis who was treated with methotrexate 10 mg intramuscular weekly and oral methylprednisolone 4mg daily. She was admitted with dyspnea, cough, fever, and oral ulcers. Thoracic computed tomography revealed bilateral alveolar low intensity areas and consolidation in peripheral region of upper and lower lobes. Other possible causes of dyspnea were excluded. Based on the clinical and radiographic findings, the patient was diagnosed with methotrexate-related pulmonary toxicity. Her overall status improved dramatically with corticosteroid therapy. The clinician should keep in mind the possibility of methotrexate-related pulmonary toxicity in cases, as in our case, since delay in diagnosis and treatment can be fatal.

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